Application on Remaining Blood Supply of Hepatic Artery in Hepatic Vascular Occlusion in Hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 楊孫虎 ¹ , 黃明哲 ¹ , 李峰 ¹ , 李坡 ² , 張振名 ²

1. ;
2. ;

Corresponding?author：

楊孫虎, Email: yangsh06@126.com

Keywords：

肝切除術; 肝血流阻斷

DOI：

10.7507/1007-9424.20140017

Video：

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目的探討保留肝動脈血供的肝血流阻斷對肝切除術失血量和肝功能的影響。方法回顧性分析了2007年9月至2012年12月期間上海交通大學醫學院附屬第三人民醫院118例行肝切除術患者的臨床資料，其中68例行保留肝動脈血供的肝血流阻斷（保留組），50例采用Pringl法行肝門阻斷（阻斷組），比較2組的手術失血量、接受輸血病例的比例、手術并發癥以及術后肝功能恢復情況。結果全組無圍手術期死亡病例。保留組患者的平均手術時間、術中失血量、接受輸血患者的比例、術后腸道功能恢復時間以及術后并發癥發生率與阻斷組相比差異均無統計學意義（P＞0.05）；術后第1天及第5天，谷丙轉氨酶及谷草轉氨酶水平保留組明顯低于阻斷組（P＜0.05）。結論保留肝動脈血供的肝血流阻斷法能有效控制肝斷面出血，明顯保護了肝臟功能，且并未延長手術時間。

Citation： 楊孫虎, 黃明哲, 李峰, 李坡, 張振名. Application on Remaining Blood Supply of Hepatic Artery in Hepatic Vascular Occlusion in Hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(1): 85-88. doi: 10.7507/1007-9424.20140017 Copy

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9.	熊奇如, 耿小平.半肝血流阻斷在肝切除術的臨床應用[J].安徽醫科大學學報, 2004, 39(1):42-44.
10.	嚴律南, 袁朝新, 張肇達, 等.應用半肝血流阻斷行肝葉切除術29例報告[J].中華外科雜志, 1994, 32(1):35-36.
11.	鄭瑞國, 竇科峰, 李軍, 等.選擇性保留半肝動脈血供的肝血流阻斷法在肝癌肝切除術中的應用[J].第四軍醫大學學報, 2009, 30(8):749-752.
12.	屠克傘, 梁傳芳, 倫增軍, 等.人體常溫下阻斷和恢復入肝血流后肝組織病理與超微結構的臨床研究[J].中國普外基礎和臨床研究, 1998, 5(4):226-227.
13.	Mücke I, Richter S, Menger MD, et al.Significance of hepatic arterial responsiveness for adequate tissue oxygenation upon portal vein occlusion in cirrhotic livers[J].Int J Colorectal Dis, 2000, 15(5-6):335-341.
14.	Richter S, Mücke I, Menger MD, et al.Impact of intrinsic blood flow regulation in cirrhosis:maintenance of hepatic arterial buffer response[J].Am J Physiol Gastrointest Liver Physiol, 2000, 279(2):G454-G462.
15.	胡建軍, 李崇輝, 王洪東, 等.保留肝動脈人肝血流阻斷法對肝硬化大鼠肝臟的保護作用[J].中華肝膽外科雜志, 2013, 19(1):62-65.

1. Smyrniotis V, Favantos C, Kostopanagiotou G, et al.Vascular control during hepatectomy:review of methods and results[J].World J Surg, 2005, 29(11):1384-1396.
2. Kooby DA, Stockman J, Ben-Porat L, et al.Influence of trans-fusions on perioperative and long-term outcome in patients follo-wing hepatic resection for colorectal metastases[J].Ann Surg, 2003, 237(6):860-869.
3. Torzilli G, Makuuchi M, Midorikawa Y, et al.Liver resection without total vascular exclusion:hazardous or beneficial? An analysis of our experience[J].Ann Surg, 2001, 233(2):167-175.
4. 王義, 陳科濟, 張友磊, 等.原發性肝癌肝切除術中延長肝門阻斷時限的探討[J].中華外科雜志, 2008, 46(10):776-779.
5. Hannoun L, Borie D, Delva E, et al.Liver resection with normo-thermic ischaemia exceeding 1 h[J].Br J Surg, 1993, 80(9):1161-1165.
6. Kim YI, Nakashima K, Toda I, et al.Prolonged normothermic ischaemia of human cirrhotic liver during hepatectomy:a preliminary report[J].Br J Surg, 1993, 80(12):1566-1570.
7. Bismuth H.Surgical anatomy and anatomical surgery of the liver[J].World J Surg, 1982, 6(1):3-9.
8. Oda M, Yokomori H, Han jY.Regulatory mechanisms of hepatic microcircuiation[J].Clin Hemorheol Microcirc, 2003, 29(1-2):167-182.
9. 熊奇如, 耿小平.半肝血流阻斷在肝切除術的臨床應用[J].安徽醫科大學學報, 2004, 39(1):42-44.
10. 嚴律南, 袁朝新, 張肇達, 等.應用半肝血流阻斷行肝葉切除術29例報告[J].中華外科雜志, 1994, 32(1):35-36.
11. 鄭瑞國, 竇科峰, 李軍, 等.選擇性保留半肝動脈血供的肝血流阻斷法在肝癌肝切除術中的應用[J].第四軍醫大學學報, 2009, 30(8):749-752.
12. 屠克傘, 梁傳芳, 倫增軍, 等.人體常溫下阻斷和恢復入肝血流后肝組織病理與超微結構的臨床研究[J].中國普外基礎和臨床研究, 1998, 5(4):226-227.
13. Mücke I, Richter S, Menger MD, et al.Significance of hepatic arterial responsiveness for adequate tissue oxygenation upon portal vein occlusion in cirrhotic livers[J].Int J Colorectal Dis, 2000, 15(5-6):335-341.
14. Richter S, Mücke I, Menger MD, et al.Impact of intrinsic blood flow regulation in cirrhosis:maintenance of hepatic arterial buffer response[J].Am J Physiol Gastrointest Liver Physiol, 2000, 279(2):G454-G462.
15. 胡建軍, 李崇輝, 王洪東, 等.保留肝動脈人肝血流阻斷法對肝硬化大鼠肝臟的保護作用[J].中華肝膽外科雜志, 2013, 19(1):62-65.

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Application on Remaining Blood Supply of Hepatic Artery in Hepatic Vascular Occlusion in Hepatectomy

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